Domestic violence is a pattern of coercive behavior used by one person to gain power and control over another in an intimate or familial relationship. 

Domestic violence can happen to anyone regardless of gender, race, sexual orientation, age, education level, socio-economic status, ethnicity, religion, or ability. There is no typical case of domestic violence. Domestic violence survivors are our neighbors, our co-workers, or our family members. Most people who experience domestic violence are women — 1 in 4 women will experience domestic violence — although men experience domestic violence, too.

In Pennsylvania alone, 112 people died in domestic violence incidents last year.

October is Domestic Violence Awareness Month. This month provides an opportunity to remember victims of domestic violence, raise awareness of what domestic violence is, how to recognize it, and what we can all do to collectively prevent it.

Where to Get Help

National Domestic Violence Hotline
    • Call: 1-800-799-SAFE (7233) or TTY: 1-800-787-3224
    • Text: “START” to 88788
    • A live online chat is also available

Pennsylvania Coalition Against Domestic Violence (PCADV)
    • Call: 1-800-932-4632 (PA); 1-800-537-2238 (National)
    • Find your local domestic violence center
Among the services provided to domestic violence survivors are: crisis intervention; counseling; accompaniment to police, medical, and court facilities; and temporary emergency shelter for survivors and their dependent children. Prevention and educational programs are provided to lessen the risk of domestic violence in the community at large.

Pennsylvania Coalition Against Rape (PCAR)
    • Call: (888) 772-PCAR
• Find your local Sexual Assault Center
PCAR is a nonprofit organization working at the state and national levels to prevent sexual violence. Founded in 1975, PCAR continues to use its voice to challenge public attitudes, raise public awareness, and effect critical changes in public policy, protocols, and responses to sexual violence. To provide quality services to victims/survivors of sexual violence and their significant others, PCAR works in concert with its statewide network of 48 sexual violence centers serving all 67 counties. The centers also work to create public awareness and prevention education within their communities.

National Sexual Violence Resource Center (NSVRC)
    • Call: 877-739-3895
The National Sexual Violence Resource Center (NSVRC) is the leading nonprofit in providing information and tools to prevent and respond to sexual violence. NSVRC translates research and trends into best practices that help individuals, communities and service providers achieve real and lasting change.

Pennsylvania Office of Victim Services
    • Find Victim Service Programs near you

Pennsylvania Department of Human Services Resources

Adult Protective Services (APS)
    • Call: 1-800-490-8505
APS was enacted to protect adults between the ages of 18 and 59 with a physical or mental disability that limits one or more major life activities. The program is meant to detect, prevent, reduce and eliminate abuse, neglect, exploitation, and abandonment. A report can be made 24/7 on behalf of the adult whether they live in their home or in a care facility such as a nursing facility, group home, hospital, etc.

ChildLine
    • Call: 1-800-932-0313
Available 24/7 to receive referrals of suspected child abuse and general child well-being concerns. Each report is handled by a trained specialist who determines the most appropriate course of action.

A Guide To Victim’s Assistance
Learn about the resources available to victims and survivors after abuse, neglect, financial exploitation, or other crimes such as domestic violence, sexual assault, simple and aggravated assault, harassment, theft, and homicide.

Additional Domestic Violence Resources

• Proclamation on National Domestic Violence Awareness and
  Prevention Month, 2022 — White House
• National Network to End Domestic Violence (NNEDV)
• Domestic Violence Awareness Project

In the United States, 54% of nurses and physicians, 60% of medical students and residents, and 61% of pharmacists have symptoms of burnout. Burnout is a long-standing issue and a fundamental barrier to professional well-being. It was further exacerbated by the COVID-19 pandemic. Health workers who find joy, fulfillment, and meaning in their work can engage on a deeper level with their patients, who are at the heart of health care. Thus, a thriving workforce is essential for delivering safe, high-quality, patient-centered care.

The National Plan for Health Workforce Well-Being is intended to inspire collective action that focuses on changes needed across the health system and at the organizational level to improve the well-being of the health workforce. As a nation, we must redesign how health is delivered so that human connection is strengthened, health equity is achieved, and trust is restored. The National Plan’s vision is that patients are cared for by a health workforce that is thriving in an environment that fosters their well-being as they improve population health, enhance the care experience, reduce costs, and advance health equity; therefore, achieving the “quintuple aim.”  Access the Plan here:  National Plan for Health Workforce Well-Being

Together, we can create a health system in which care is delivered joyfully and with meaning, by a committed team of all who work to advance health, in partnership with engaged patients and communities.

Thanks to the Inflation Reduction Act, enrollees will have lower costs for insulin and free ACIP-recommended vaccines starting in 2023.  People with Medicare should review their coverage and drug and health plan options through December 7, 2022 on Medicare.gov

Medicare Open Enrollment begins tomorrow — Saturday, October 15 — and will remain open through December 7, 2022. Medicare’s Open Enrollment period gives people with Medicare the opportunity to make changes to their health plan or prescription drug plan, pick a Medicare Advantage plan, or return to Original Medicare (also referred to as Medicare Part A and Part B). Medicare plans can change their offerings and costs every year, and individuals’ health needs can change from year-to-year, too. Now is the time for people with Medicare to review their coverage options and make a choice that best meets their health care needs.

The Biden-Harris Administration has made expanding access to health insurance and lowering health care costs for America’s families a top priority. Just last month the Biden-Harris Administration announced that people with Medicare will see lower average premiums for Medicare Part B, Medicare Advantage, and Medicare Part D prescription drug plans in 2023.

This year, thanks to the Inflation Reduction Act that President Biden signed into law in August, Medicare enrollees will also see lower costs for insulin and vaccines beginning in 2023. Starting in 2023, all people with Medicare who take insulin covered by their prescription drug plan or through a traditional pump covered under Original Medicare will pay no more than $35 in cost-sharing for a month’s supply of each covered insulin product. People with Medicare also will not pay a deductible with respect to each covered insulin product. Additionally, people with Medicare drug coverage will pay nothing out-of-pocket for adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) — including the shingles vaccine and Tetanus-Diphtheria-Whooping Cough vaccine. More information on the Inflation Reduction Act and these changes is available at https://www.cms.gov/newsroom/fact-sheets/inflation-reduction-act-lowers-health-care-costs-millions-americans.

“This year, more than ever, it is vital that people with Medicare review and compare their options to find the coverage that best meets their needs,” said HHS Secretary Xavier Becerra. “Thanks to the Inflation Reduction Act, we are lowering the cost of insulin and vaccines for the more than 64 million people with Medicare. The Biden-Harris Administration is unwavering in our commitment to strengthening Medicare, and we will keep doing all we can to lower costs and improve benefits.”

“We are committed to providing comprehensive and easily accessible information to support people with Medicare in their decision making,” said CMS Administrator Chiquita Brooks-LaSure. “Medicare.gov makes it easier than ever to compare coverage options and shop for plans. People can do a side-by-side comparison of plan coverage, costs, and quality ratings to help them more easily see the differences between plans.”

Since 2021, CMS has introduced a number of enhancements to Medicare.gov to optimize customer experience and create a more welcoming and user-friendly experience. Improvements include a redesigned Medicare.gov home page, the addition of pricing details to the Medigap policy comparison, streamlined landing and summary on the Medicare Plan Finder, and a redesigned “Talk to Someone” section to find additional help and contacts. All of these enhancements improve the overall experience, making it easier to navigate and access information to compare and select health and drug coverage and find providers.

The Medicare Open Enrollment period occurs every year from October 15 through December 7, with coverage changes taking effect January 1.

Things to Consider When Shopping for Medicare Coverage       

• There are two main ways to get your Medicare coverage — Original Medicare and Medicare Advantage (Medicare-approved plans from private companies). There are differences between the two that are important to understand when choosing your coverage.
• If you are selecting a Medicare Advantage plan, check with your health care providers to confirm they are in a plan’s network.
• If you are selecting a Medicare prescription drug plan, check if your prescriptions are included on a plan’s formulary.
• Remember that a low monthly premium may not always be the best overall value to meet your specific needs.
• Review a plan’s estimated total costs to you, including deductible and other out-of-pocket costs.
• If you take insulin, there is a new out-of-pocket cap on a month’s supply of each insulin product when covered by a prescription drug plan or under Original Medicare. Talk to someone for help comparing plans by calling 1-800-MEDICARE

Medicare is Here to Help

Here are four ways you can compare plans and look at savings options:

1. Go to Medicare.gov to learn the difference between Original Medicare and Medicare Advantage, and do side-by-side comparisons of costs and coverage for Medicare Advantage and prescription drug plans.
2. Call 1-800-MEDICARE. Help is available 24 hours a day, including weekends.
3. Access personalized health insurance counseling at no cost, available from State Health Insurance Assistance Program (SHIP). Visit shiphelp.org or call 1-800-MEDICARE for each SHIP’s phone number. Many SHIPs also offer virtual counseling.
4. Check eligibility for Medicare Savings Programs. If you have limited income and resources, you could qualify for Medicare Saving Programs run by your state Medicaid program. These programs could help save you money on health and prescription drug costs and/or could reduce your Part B premium from $165 to $0. For more information, contact your state Medicaid program or call 1-800-MEDICARE and ask about Medicare Savings Programs.

For more information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048. Help is available 24 hours a day, including weekends.

On October 11, 2022, the Internal Revenue Service released a final rule that changes the way health insurance affordability is determined for members of an employee’s family, beginning with plan year (PY) 2023 coverage. Beginning in 2023, if a consumer has an offer of employer-sponsored coverage that extends to the employee’s family members, the affordability of that offer of coverage for the family members (of the employee) will be based on the family premium amount, not the amount the employee must pay for self-only coverage.

The final rule is effective for PY2023. The change will be reflected in the online application through the HealthCare.gov enrollment platform and enhanced direct enrollment certified partner applications during the PY2023 Open Enrollment period beginning November 1, 2022. State-based Marketplaces not using the HealthCare.gov enrollment platform are also working to implement this change, but may have different implementation timelines.

To view the final rule, visit: https://www.federalregister.gov/public-inspection/2022-22184/affordability-of-employer-coverage-for-family-members-of-employees.

U.S. Department of Agriculture (USDA) Rural Development State Director Bob Morgan today announced that USDA is awarding $1.8 million in grants to improve health care facilities in rural towns in Pennsylvania. These grants will help two health care organizations and one food bank.

“Emergency Rural Health Care Grants support rural communities in providing health care to the people and places that often lack access,” Morgan said.

The projects awarded in this round of funding are:

• The Elk Haven Nursing Home Association received a grant of $767,200 to reimburse lost healthcare revenue.
• The City of Braford in McKean County received a grant of $105,100 to purchase an ambulance.
• The Chester County Food Bank received a grant of $1 million to reimburse costs of food purchases because of the COVID-19 pandemic.

You can read the complete news release here.

The Rural Health Value team recently released two new Rural Innovation Profiles:

Experience in the Pennsylvania Rural Health Model: Barnes-Kasson County Hospital
A critical access hospital in Susquehanna, PA provides insight into their experience participating in the Pennsylvania Rural Health Model, which includes a global budget and transforming care to address community health needs.

MaineHealth ACO – Integrating and Using Data to Support Care Delivery
A predominantly rural network of hospitals and clinics in Maine integrates clinical and claims data to support improvements in care delivery and target patient needs as part of their Accountable Care Organization.

Related resources on the Rural Health Value website:

• Catalog of Value Based Initiatives for Rural Providers – One-page summaries describe rural-relevant, value-based programs currently or recently implemented by the Department of Health and Human Services (HHS), primarily by the Centers for Medicare & Medicaid Services (CMS) and its Center for Medicare & Medicaid Innovation (CMMI).
• Guide to Selecting Population Health Management Technologies for Rural Care Delivery – Better manage the health of existing patient populations by implementing technology with this guide from Rural Health Value that walks you through the process to plan for and implement the technology.
• Value-Based Care Assessment – This tool helps a rural organization assess readiness for the shift of healthcare payments from volume to value. The resulting report may be used to guide the development of action plans.

 Contact information:

Clint MacKinney, MD, MS, Co-Principal Investigator, clint-mackinney@uiowa.edu

Rural Health Value helps create high performance rural health systems by building and offering an actionable knowledge base through research, practice, and collaboration. Visit www.ruralhealthvalue.org.

It may sound like a good problem to have – lots of extra money for rural healthcare facilities during a medical crisis. But state Offices of Rural Health found that hospitals needed extra assistance to use the pandemic-related funds effectively.

When billions of dollars in federal funding started flowing into rural healthcare agencies as part of the American Rescue Plan, facilities turned to State Offices of Rural Health for assistance in how to use it.

Shortly after the public health emergency declaration, nearly $400 million in funding went to 1,540 rural hospitals with fewer than 50 beds through the Small Rural Hospital Improvement Program (SHIP).

Those funds were to go toward operational improvements including hardware, software and training. Additionally, the Federal Office of Rural Health Policy developed a number of programs for Medicare-Certified Rural Health Clinics (RHCs) that provided each hospital with $49,000 (in May 2020) for Covid-19 testing, another $100,000 (in June 2021) for Covid testing and mitigation, and another $50,000 (in July 2021) for Covid vaccination confidence programs.

State Offices of Rural Health helped RHCs in their own states apply for funding and track how that funding was spent. But, since each state office is different, how the state offices responded to the crises varied.

In some states, Offices of Rural Health are a function of the state government. But many are not. Tammy Norville, CEO of the National Organization of State Offices of Rural Health (NOSORH), said in an interview with the Daily Yonder that each state is different. Three state Offices of Rural Health are non-profit organizations, while 13 are located in academic settings – either universities or community colleges. The rest, she said, are part of state government. Those located in state government, Norville said, are most often located in their state’s Department of Health and Human Services, except for one which is located in the state’s Department of Agriculture.

“We like to say, when you’ve seen one state Office of Rural Health, you’re really seen one state office of rural health,” Norville said. “They’re all set up differently. Even the ones in state government offices. They’re different in how they’re staffed, how the work is distributed. It’s all depends on the state they’re in.”

At NOSORH, the goal was to provide support to state offices of rural health as they, in turn, supported their RHCs.

In some cases, that meant taking the pulse of what was going on during the pandemic and highlighting some of the best practices that were going on among the offices.

For individual state Offices of Rural Health, the funding for Rural Health Clinics came at a critical time.

Robert Duehmig, interim director of the Oregon Office of Rural Health, said in an interview with the Daily Yonder that the money was needed, but almost overwhelming.

“The amount of money that flowed from the federal government and from the state government and different entities was huge,” he said. “And it was done at a time where even if we were fully staffed, we’re not huge offices, and neither are a lot of our clinics. We were starting to close down for a period of time. The expectations of some of those funds I think were often or somewhat unrealistic.”

The Oregon Office of Rural Health’s role in distributing that money was to make sure the hospitals were eligible and to help them identify how they were going to spend those funds. Once the hospitals had signed an agreement on how they would spend those funds, the state office would distribute them.

Some eligible hospitals chose not to take the federal funds though. Five rural hospitals in Oregon did not. Duehmig said it was not that they didn’t need it or that they weren’t eligible, but that in some cases they were having trouble finding expenses to apply those funds to. In other cases, there just wasn’t enough manpower in the hospital to monitor and record how the funds were used.

In Michigan, John Barnas, executive director of Michigan Center for Rural Health, said the relationship between the center and the state health organization was key in getting grant money to the right communities.

Working with the Michigan Department of Health and Human Services, the Michigan Center for Rural Health was able to cooperatively get funding to needy rural communities. And by looking at the data, the center was able to find populations that needed the funding the most.

“We utilized population-based data to look at age demographics, race, ethnicity demographics, poverty demographics,” Barnas said. “We also looked at data around immunization levels for flu and Covid-19.”

Norville said the money came as a blessing, but also as a curse. At a time when rural health clinics were at their busiest, she said, the federal government was throwing money at them, requiring them to spend it in certain ways, and asking them to track how they spent it. That meant more labor to monitor how the money was spent, she said.

“Just think about the effort that it took to do that in the middle of a public health emergency… but these guys did it, I mean, that’s the story, right? Regardless of what left hooks came at them, they rose to the challenge. And they did what they needed to do to take care of things.”